Cultural Adaptations: Conceptual, Ethical, Contextual, and Methodological Issues for Working with Ethnocultural and Majority-World Populations

Abstract

Mayor advancements have been achieved in research on the cultural adaptation of prevention and treatment interventions that are conducted with diverse ethnocultural groups. This commentary addresses conceptual, ethical, contextual, and methodological issues related to cultural adaptations. The articles in this special issue represent a major contribution to the study of cultural adaptations in prevention science. We frame our analysis of fidelity to core intervention components using a conceptual approach that examines (a) the propositional model (theory of change), (b) the procedural model (theory of action, methods), and (c) the philosophical assumptions that undergird these models. Regarding ethics, we caution against imposing the norms, values, and world views of the Western dominant society onto vulnerable populations such as ethnocultural groups. Given that the assumption of universality in behavioral science has been questioned, and as randomized clinical trials (RCTs) seldom examine the ecological validity of evidence-based interventions and treatments (EBI/T), imposing such interventions onto ethnocultural groups is problematic since these interventions contain values, norms, beliefs, and worldviews that may be contrary to those held by many ethnocultural groups. Regarding methods, several innovative designs are discussed that serve as alternatives to the RCT and represent an important contribution to prevention science. Also, we discuss guidelines for conducting cultural adaptations. Finally, the articles in this special issue make a major contribution to the growing field of cultural adaptation of preventive interventions with ethnocultural groups and majority-world populations.

Advances in EBI Development for Diverse Populations: Towards a Science of Intervention Adaptation

“…Guillermo Bernal is a senior investigator who has published extensively on the topic of cultural adaptations and has developed models that examine important components of cultural adaptations. In their commentary, Bernal and Adames (2017, this issue) question the adaptation strategy of maintaining the EBI’s “core components,” arguing that limited empirical evidence exists regarding the effects of an EBI’s putative core components as essential influences on targeted behavior change outcomes. Bernal and Adames also describe a conceptual framework that distinguishes an EBI’s propositional model (theory of change) from its procedure model (action and methods) (Bernal & Adames, 2017, this issue).…”

“…In their commentary, Bernal and Adames (2017, this issue) question the adaptation strategy of maintaining the EBI’s “core components,” arguing that limited empirical evidence exists regarding the effects of an EBI’s putative core components as essential influences on targeted behavior change outcomes. Bernal and Adames also describe a conceptual framework that distinguishes an EBI’s propositional model (theory of change) from its procedure model (action and methods) (Bernal & Adames, 2017, this issue). This analysis underscores the importance of theoretical congruence in conducting adaptations that can also retain fidelity to the EBI’s core intervention aims.…”

“…In these cases, adherence to that EBT’s or EBI’s theoretical foundations when in conflict with a client’s cultural “world view,” could impose culturally-dystonic values that can be detrimental to the client’s well-being (Bernal & Adames, 2017, this issue). These investigators also note that future adaptations research may identify new emergent principals and guidelines for increasing intervention effectiveness.…”

Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos

“…FA was then evaluated in 2006 with six cohorts of families in a school-based setting. Findings were positive showing that family and peer communication improved and perceptions of substance use harm increased while social norms around sexual behavior and past-30-day use of marijuana and illegal drugs were reduced [68]. The developers also conducted NIH-supported work to infuse the FA curriculum with reproductive health education and HIV prevention messaging.…”

Culture, identity, strength and spirituality: A qualitative study to understand experiences of African American women breast cancer survivors and recommendations for intervention development

“…Cultural adaptation interventions will require input from the community. Interventions for racial ethnic minorities that are not culturally adapted or that are inadequately adapted will likely result in less participant engagement, compliance, and retention, and will eventually be less effective (Bernal & Adames, 2017;Castro, Barrera, & Martinez, 2004).…”